Management of acquired dacryocystitis.

Acquired dacryocystitis that has its onset after the first year of life is due to fibrotic obstruction within the lacrimal drainage pathways that is usually secondary to trauma or infection. Staphylococcus aureus is the most common pathogen, but attempts should be made to express or aspirate material from the lacrimal sac for culture and antibiotic sensitivity testing. When the strain is resistant to penicillin or when a culture specimen is not obtainable, cloxacillin is the antibiotic of choice. The timing of application of hot compresses is important so that the swelling can be localized to the sac but perforation will not be induced. Once the inflammation has resolved, dacryocystorhinostomy may be needed to drain residual fluid. Dacryocystography is useful to indicate whether there is persistent obstruction or stenosis; if the results are normal but symptoms persist, scintiscanning may demonstrate a delay of tear flow out of the sac or may reveal a stone.